Conditional Admission for Child Care and TK/K-12 in California

1. Conditional Admissions California Department of Public Health, Immunization Branch

2. Conditional Admission for Child Care California Code of Regulations • A valid Temporary Medical Exemption requires submission of a licensed physician’s written statement which states: • the physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated; • the vaccine(s) to be exempted; and • the date the temporary medical exemption will end. Children must meet one of these conditions for conditional admission:

3. Refer to “Laws” Tab for Details

4. Conditional EntrantsFor Child Care Self Check Under which three conditions may children be admitted into child care as conditional entrants?

5. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission Under 18 months old? Look to Guide for Immunizations Required for Child Care or Preschool to determine if the child may be admitted. Eileen, I added this slide to distinguish between conditional admissions under 18 mos and over 18 mos old.

6. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission 18 months or older and missing doses for age? Look to Table 2 to determine if the child may be admitted.

7. Implement Immunization RequirementsPreparing for a Child’s 1stDay: Conditional Admission • Use Notice of Immunizations Needed letter to notify parents of vaccines due before admission.

8. Conditional Entrants: Under 18 Months Old Throughout the Year Determine timing for the next dose in a series: Children are due for the next dose in a series at the beginning of the age category.

9. Conditional Entrants: 18 Months or Older Throughout the Year Determine timing for the next dose in a series:

10. Conditional EntrantsThroughout the Year Step by Step: • Create a reminder entry in your follow-up system to notify parents or guardians when next shots are due. • Use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for Child Care or Preschool to inform parents of the next doses needed. Please make sure you include the deadline. • Review records at least every (30) days. If you discover a child has missed the next dose and was not excluded, child-care facilities must notice parents or guardians and may give them up to (10) school days to comply before the child is excluded.

11. Conditional Entrants: Under 18 Months OldFor Child Care Steps Compare number of doses on his Blue Card to Guide to Immunizations Required for Child Care or Preschool. Jose will need an additional polio shot, additional dose of Hib (on or after 1st birthday), and (1) MMR (on or after 1st birthday). Contact and send parents the Notice of Immunizations Needed letter. Create another entry in your follow-up system to ensure that those doses are received when due. Self Check Today is November 2, 2015. You are running your monthly follow-up report and are reminded that Jose will turn 15 months and age into new requirements in one month. What will you do?

12. Conditional Admissions California Department of Public Health, Immunization Branch

13. Describe How Children May Be AdmittedConditional Admission for TK/K-12 California Code of Regulations • A valid Temporary Medical Exemption requires submission of a licensed physician’s written statement which states: • the temporary physical condition or medical circumstance of the child is such that the required immunization(s) is not indicated; • the date when the temporary medical exemption will end, and • the vaccine(s) to be exempted. Children must meet one of these conditions for conditional admission:

14. Refer to “Laws” Tab for Details

15. Conditional EntrantsFor TK/K-12 Self Check Under which two conditions may children be admitted in TK/K-12 as conditional entrants?

16. Conditional EntrantsThroughout the Year Determine timing for the next dose in a series:

17. Conditional EntrantsThroughout the Year Step by Step: • Create a reminder entry in your follow-up system to notify parents or guardians when next shots are due. • You may use the Notice of Immunizations Needed letter and Parents’ Guide to ImmunizationsRequired for School Entry to inform parents of the next doses needed. Please make sure you include the deadline. • Recommend that the child receive the next dose at the beginning of the vaccine’s time interval from Table 2. • Review records every (30) days. If you discover a child has missed the next dose and was not excluded, schools must notice parents or guardians and may give them up to (10) school days to comply before the child is excluded.

18. Conditional EntrantsFor TK/K-12 Steps No.  You will count doses on the Blue Card and compare to the Guide to Immunizations Required for School Entry. She is behind on DTaP. Compare the immunization dates on the Blue Card to Table 2 for interval timing to determine if the next dose must be administered before starting school. The third dose is due “before admission if 8 or more weeks have elapsed since the 2nd dose at the time of admission.” What are your next steps? Self Check Today is July 25, 2016. Anna is five years old and is starting kindergarten in 1 month.  Her last (2nd) dose of DTaP was 5 months ago.  Can she start classes in a month?

19. Create an Immunization PlanFollow-up for Conditional Entrants James Doe 2nd MMR Jane Doe 3rd DTP Set a schedule and check your follow-up system every 30 days for children with pending vaccinations.

20. Personal Beliefs Exemptions No Longer an Option for New Admissions (Effective 1/1/2016) Summary of Senate Bill 277 (Pan, 2015) Effective January 1, 2016, parents of students in any school or child-care facility are no longer allowed to submit a new personal beliefs exemption (PBE) to a currently required vaccine. A PBE filed before 2016 at: A child-care facility will remain valid until the child first enters the span between TK/K through 6th grade. Entry to any grade from TK/K through 6th grade will remain valid until the child completes 6th grade. Entry to any grade from 7th through 12th will remain valid through 12th grade. Students are no longer required to have immunizations for entry if they attend a home-based private school or an independent study program and do not receive classroom-based instruction. For these students, parents must continue to provide immunization records to their schools and schools must continue to maintain and report records of immunizations. Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.